High coronary plaque burden in PsA patients

medwireNews: Psoriatic arthritis (PsA) is associated with accelerated coronary plaque formation independently of metabolic disease, according to results from a single-center study.

Oliver FitzGerald (St Vincent’s University Hospital, Dublin, Ireland) and colleagues enrolled 50 individuals with PsA (half with the metabolic syndrome) and 50 age- and sex-matched controls, none of whom had a history of coronary artery disease.

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As assessed by 64-slice coronary computed tomography angiography, a significantly higher proportion of patients with PsA than controls (76% vs 44%) were found to have coronary plaques. One, two-, and three-vessel disease, respectively, was present in 42%, 14%, and 20% of PsA patients, compared with 20%, 14%, and 10% of controls.

However, the proportion of individuals with coronary plaques did not differ among PsA patients according to the presence or absence of metabolic syndrome (72% and 80%, respectively).

Compared with controls, PsA patients had a significantly higher segment involvement score, stenosis severity score, and total plaque volume. A greater proportion of patients with PsA had mixed plaques (MP) and the mean MP volume was also higher in patients versus controls, which the researchers describe as “[o]ne of the most striking findings” of the study. They add: “The higher prevalence and extent of MP found in our patients may strengthen the well-established relationship between PsA and the higher frequency of cardiac events.”

Several demographic and PsA-related factors, such as age, maximum swollen joint count, and disease duration, were independent predictors of higher plaque burden. However, none of the components of the metabolic syndrome correlated significantly with quantitative plaque scores. And linear regression analyses showed that PsA was an independent predictor of total plaque volume.

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Treatment appeared to have a limited effect on these findings, with no significant differences in any of the quantitative plaque measures between PsA patients treated with conventional versus biologic DMARDs.

The researchers conclude in Arthritis & Rheumatology: “While there is a lack of evidence for more aggressive treatment for reducing the risk of adverse [cardiovascular] outcomes, our findings, that psoriatic disease activity and severity may predict coronary plaque burden better than traditional risk factors, suggest that achieving minimal disease activity or remission may have a beneficial effect in preventing future [cardiovascular] events in PsA.”